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General NPI Number Information
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NPI Number | 1649582842
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Entity Type | Individual
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Provider Name | MARCO PHILIP FLORIDIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 1200 N STATE ST DEPARTMENT OF RADIOLOGY
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City | LOS ANGELES
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State | CA
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Zip | 90033-1029
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Country | US
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Telephone | 323-226-7677
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Fax |
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Provider Business Mailing Address
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Address Line | 385 E GREEN ST APT. 2221
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City | PASADENA
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State | CA
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Zip | 91101-2321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A111801
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License Number State | CA
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